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Component 13:Public Health IT

Instructor Manual

Version 3.0/Spring 2012

Notes to Instructors

This Instructor Manual is a resource for instructors using this component. Each component is broken down into units, which include the following elements:

Learning objectives Suggested student readings, texts, reference links to supplement the narrated

PowerPoint slides Lectures (voiceover PowerPoint in Flash format); PowerPoint slides (Microsoft

PowerPoint format), lecture transcripts (Microsoft Word format); and audio files (MP3 format) for each lecture

Self-assessment questions reflecting Unit Objectives with answer keys and/or expected outcomes

Application Activities (e.g., discussion questions, assignments, projects) with instructor guidelines, answer keys and/or expected outcomes

Health IT Workforce Curriculum Public Health IT 2Version 3.0/Spring 2012

This material was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003.

Contents

Notes to Instructors..........................................................................................................2

Contents...........................................................................................................................3

Component Overview.......................................................................................................4

Component Authors.........................................................................................................5

Disclaimer........................................................................................................................7

Component 13/Unit 1.......................................................................................................8

Component 13/Unit 2.....................................................................................................13

Component 13/Unit 3.....................................................................................................16

Component 13/Unit 4.....................................................................................................21

Component 13/Unit 5.....................................................................................................25

Component 13/Unit 6.....................................................................................................29

Component 13/Unit 7.....................................................................................................32

Component 13/Unit 8.....................................................................................................35

Component 13/Unit 9.....................................................................................................38

Component 13/Unit 10...................................................................................................41

Component Acronym Glossary......................................................................................43

Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported....................46



Component Overview

This component is specifically for individuals interested in a career in public health. This component will provide an overview of specialized public health applications such as registries, epidemiological databases, biosurvelliance, public health reporting alerts, quality reporting, and how to adopt/use of population health functions for electronic health records and consumer functions for personal health records. In addition, this component will address the potential of public health information technology for health promotion and chronic disease prevention.

Component ObjectivesAt the completion of this component, the student will be able to:

Distinguish (draw distinctions) among core functions and essential services of ‘public health’ and ‘clinical care’.

Synthesize key reasons and current contextual factors for providers in clinical practice to improve public health services and practices using EHRs.

Apply health data definitions and standards, as well as privacy and confidentiality issues, in typical public health scenarios.

Summarize the strategies, features, and systems needed for public health agencies to define and build the necessary connections to EHRs as identified by meaningful use legislation.

Describe the roles and functions of existing public health data and health databases and networks.

Identify current needs and future directions for EHR biosurveillance, disaster-preparedness, and situational awareness in improving public health.

Summarize/describe the main role, functions and applications of public health reporting, alerts and decision support systems.

Summarize the role, functions and applications of public health IT for health promotion and chronic disease prevention.

Delineate the critical role of advocacy in adoption/use of EHRs and Consumer functions for PHRs to improve public health.



Component Authors

Assigned Institution Columbia University, New York, NY

Team Lead Rita Kukafka, DrPH, MAAssociate Professor, Department of Biomedical Informatics (DBMI) and the Mailman School of Public Health (Sociomedical Sciences), and Director of the Health Communication and Informatics Laboratory at DBMI, Columbia UniversityDr. Kukafka maintains an active, funded program of research and publication in public health informatics while being engaged in major leadership roles in the field. Her research is at the crossroads of Biomedical Informatics and Public Health and focuses on the use of Web 2.0 technologies (social software) to develop and strengthen communities and people-networks, and use of participatory action methods for re-engineering, system design and evaluation. One area of research is computer interventions for chronic disease self-management, health promotion and informed decision-making, patient-focused electronic health records and personal health records, tailoring health communication, and interactive computer graphics for communicating health risk probabilities to patients. Another area of her research focuses on how theory from the behavioral sciences can be applied to advance our understanding and to improve our capacity to implement information technology systems into health care organizations. She is a member of the American Medical Informatics Association (AMIA) Board of Directors and she is a past chair of that organization's Working Group on Consumer Health Informatics.

Primary Contributing Authors Lynda Carlson, Ph.D Director of Health Information Technology at Borough of Manhattan Community College (BMCC)

Michael Buck, PhDNYC Department of Health and Mental Hygiene (NYCDHMH) and Associate Research Scientist in the Department of Biomedical Informatics (DBMI) at Columbia University

Anna Ritko, PhD Candidate Content Specialist, Department of Biomedical Informatics, Columbia University

Winfred Wu, MDNYC Department of Health and Mental Hygiene (PCIP)

Sarah Shih, MPH NYC Department of Health and Mental Hygiene (PCIP)



Marlena Plagianos, MSNYC Department of Health and Mental Hygiene (PCIP)

Lecture NarrationJoel Richardshttp://joelrichards.com/ Sound EngineerAcacia Graddy-GamelColumbia University, New York, NY

Team MembersSyncia Sabain, EdD Project Manager, Columbia University

Elizabeth Oliver, BCC Content Specialist, Bronx Community College

Madhabi Chatterji, PhD Curriculum Developer, Teachers College, Columbia University

John Allegrante, PhD Curriculum Developer, Teachers College, Columbia University

John Zimmerman, DDS Instructional Designer, Columbia University

Cindy Smalletz, MA Instructional Designer, Columbia University



http://joelrichards.com/

Disclaimer

These materials were prepared under the sponsorship of an agency of the United States Government. Neither the United States Government nor any agency thereof, nor any of their employees, makes any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of any information, apparatus, product, or process disclosed, or represents that its use would not infringe privately owned rights. Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply its endorsement, recommendation, or favoring by the United States Government or any agency thereof. The views and opinions of authors expressed herein do not necessarily state or reflect those of the United States Government or any agency thereof. Likewise, the above also applies to the Curriculum Development Centers (including Columbia University, Duke University, Johns Hopkins University, Oregon Health & Science University, University of Alabama at Birmingham, and their affiliated entities).

The information contained in the Health IT Workforce Curriculum materials is intended to be accessible to all. To help make this possible, the materials are provided in a variety of file formats. Some people may not find the Flash video and .SWF files accessible and should instead utilize the PowerPoint slides together with the .mp3 audio file and/or Word transcript to access the lectures. For more information, please visit the website of the National Training and Dissemination Center at http://www.onc-ntdc.org or http://www.onc-ntdc.info to set up a profile and view the full accessibility statement.



http://links.govdelivery.com/track?type=click&enid=bWFpbGluZ2lkPTEzOTUyNzImbWVzc2FnZWlkPVBSRC1CVUwtMTM5NTI3MiZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTEyNzY2NDc4MzkmZW1haWxpZD1taWNoZWxsZS5tdXJyYXlAaGhzLmdvdiZ1c2VyaWQ9bWljaGVsbGUubXVycmF5QGhocy5nb3YmZmw9JmV4dHJhPU11bHRpdmFyaWF0ZUlkPSYmJg==&&&102&&&http://www.onc-ntdc.info

http://www.onc-ntdc.org/

Component 13/Unit 1

Unit TitleOverview & Contribution to Public Health Through Electronic Health Record Use

Unit DescriptionThis unit will synthesize key reasons and current contextual factors for providers in clinical practice to improve public health practice using Electronic Health Records (EHRs).

Unit Objectives By the end of this unit, the student will be able to:

1. Explain what is public health? 2. Discuss what distinguishes public health from the other health sciences 3. Explain public health’s unique contributions to the health of the public4. To define Public Health (PH) Information Technology and PH Informatics 5. To illustrate how innovative IT solutions are being applied to PH practice6. To explain the role of electronic health records and data exchange to

clinical care and health care improvement7. Describe PH organizational structure

Unit Topics / Lecture Titles A. Introduction to Public HealthB. Historical Context of Public HealthC. Opportunities for Public Health enabled electronic health recordsD. Public Health + Health Information Technology (PHIT)E. Public Health Informatics

Unit References(All links accessible as of 1/1/2014)

Lecture 1a1. Novick, L.F., Morrow, C.B. Defining public health: history and contemporary

developments; chapter 1. Retrieved on June 10th, 2010 from http://www.jblearning.com/samples/0763738425/38425_CH01_001_034.pdf.

2. Action model to achieve healthy people 2020 overarching goals. Retrieved on June 10th 2010 from http://healthypeople.gov/2020/#_Toc212885445

3. Healthy People 2020 Threats to Public Health facts. Retrieved on June 10th, 2010 from http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=41.

4. Screening for obesity in adults. (2003). U.S Preventive Services Task Force. Retrieved on June 10th, 2010 from



http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=41.

http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=41.

http://healthypeople.gov/2020/%23_Toc212885445

http://www.jblearning.com/samples/0763738425/38425_CH01_001_034.pdf.

http://www.uspreventiveservicestaskforce.org/uspstf/uspsobes.htm. 5. Whitlock, E.P., O’Connor, E.A., Williams, S.B., Beil, T.L., Lutz, K.W. (2009). 6. Effectiveness of weight management interventions in children: a targeted

systematic review for the USPSTF. Retrieved on June 10th, 2010 from http://www.uspreventiveservicestaskforce.org/uspstf10/childobes/chobesart.pdf.

7. Threats to the public’s health: infectious diseases. Retrieved on June 10th 2010 from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=23.

8. Threats to the public’s health: infectious diseases. Retrieved on June 10th 2010 from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=23.

9. Health People 2010 Infectious Diseases. Retrieved on June 10th 2010 from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=23.

10.Retrieved June 10, 2010 from http://www.healthypeople.gov/2020/about/disparitiesAbout.aspx.

11.Economic consequences of chronic diseases and the economic rationale for the public and private intervention. (2005). Oxford Health Alliance working group. OHA 2005 conference. http://archive.oxha.org/meetings/knowledge/publications/05-meeting-documentation/economics_of_chronic_disease_26oct.pdf.

12.The vision, mission, and goals of Healthy People 2020. Department of Health and Human Service. Retrieved June 10th 2010 from http://healthypeople.gov/2020/consortium/HP2020Framework.pdf.

13.Retrieved June 10th, 2010 from http://www.nap.edu/openbook.php?record_id=10548&page=49.

14.Retrieved June 10th, 2010 from http://www.nap.edu/openbook.php?record_id=10548&page=49

15.The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Department of Health and Human Services. Retrieved June 10th, 2010 from http://www.surgeongeneral.gov/library/secondhandsmoke/report/fullreport.pdf.

16.Self-created map of London water pumps using Epi Map Generated using CDC Epi Map Module in Epi Info 2000 for Windows, a public domain package that can be downloaded from: http://www.cdc.gov/epiinfo/EI2000.htm

17.Retrieved June 10th, 2010 from http://www.flickr.com/photos/lwr/4346005957/sizes/l/#cc_license.

18.Retrieved June 10th, 2010 from http://www.cdc.gov/nchs/healthy_people/hp2010/data2010.htm.

19.Retrieved June 10th, 2010 from googleimages.com. https://www.google.com/search?hl=en&client=firefox-a&hs=UMS&rls=org.mozilla:en-US:official&q=images%20from%202001%20terrorist%20attack%20antrax&bav=on.2,or.r_gc.r_pw.,cf.osb&biw=1672&bih=904&um=1&ie=UTF-



https://www.google.com/search?hl=en&client=firefox-a&hs=UMS&rls=org.mozilla:en-US:official&q=images%20from%202001%20terrorist%20attack%20antrax&bav=on.2,or.r_gc.r_pw.,cf.osb&biw=1672&bih=904&um=1&ie=UTF-8&tbm=isch&source=og&sa=N&tab=wi&ei=hjMxT5aIEOm80AGBz_DaBw


http://www.cdc.gov/nchs/healthy_people/hp2010/data2010.htm

http://www.flickr.com/photos/lwr/4346005957/sizes/l/#cc_license

http://www.cdc.gov/epiinfo/EI2000.htm

http://www.surgeongeneral.gov/library/secondhandsmoke/report/fullreport.pdf

http://www.nap.edu/openbook.php?record_id=10548&page=49




http://healthypeople.gov/2020/consortium/HP2020Framework.pdf

http://archive.oxha.org/meetings/knowledge/publications/05-meeting-documentation/economics_of_chronic_disease_26oct.pdf

http://archive.oxha.org/meetings/knowledge/publications/05-meeting-documentation/economics_of_chronic_disease_26oct.pdf

http://www.healthypeople.gov/2020/about/disparitiesAbout.aspx.%20

http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=23.

http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=23.

http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=23.%20




http://www.uspreventiveservicestaskforce.org/uspstf10/childobes/chobesart.pdf.%20

http://www.uspreventiveservicestaskforce.org/uspstf/uspsobes.htm

8&tbm=isch&source=og&sa=N&tab=wi&ei=hjMxT5aIEOm80AGBz_DaBw. 20.Centers for Disease Control and Prevention: Obesity trends among U.S adults

between 1985-2010. Retrieved June 10th, 2010 from www.cdc.gov/obesity/downloads/obesity_trends_2010.ppt.

21.HealthCare Spending: money alone does not extend lives. Retrieved on June 10th, 2010 from http://ucatlas.ucsc.edu/spend.php.

22.Flores, G.R. (2002). Implications for public health practice: The future of the Public’s Health in the 21st Century. Institute of Medicine. Retrieved June 10th, 2010 from http://www.iom.edu/~/media/Files/Report%20Files/2002/The-Future-of-the-Publics-Health-in-the-21st-Century/Flores.pdf.

Lecture 1a ImagesSlide 23: Retrieved June 10th, 2010 from http://www.nap.edu/openbook.php?record_id=10548&page=49 Slide 24: Retrieved June 10th, 2010 http://www.nap.edu/openbook.php?record_id=10548&page=49Slide 27: Action model to achieve healthy people 2020 overaching goals. Retrieved June 10th, 2010 from http://www.healthypeople.gov/hp2020/advisory/PhaseI/sec4.htm#_Toc212885445 Slide 29: The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Department of Health and Human Services. Retrieved June 10th, 2010 from http://www.surgeongeneral.gov/library/secondhandsmoke/report/fullreport.pdf

Lecture 1b 1. Hanrachan, L.P. (2004). Public health informatics the Wisconsin Idea. PHDSC

Annual meeting. Retrieved June 10th, 2010 from www.phdsc.org. 2. Kukafka, R., Ancker, J.S., Chan, C., et al. (2007). Redesigning electronic health

record systems to support public health. Journal of Biomedical Informatics, vol.40(special issues), p. 398-409.

3. Snow J. On the mode of communication of cholera. 2nd ed. In: Snow on Cholera. (Reprint.) New York, New York: Hafner Publishing Co., 1965. Available at http://www.ph.ucla.edu/epi/snow.html.

4. Yasnoff, W.A., Overhage, J.M., Humphreys, B.L., LaVenture, M. (2001). A national agenda for public health informatics: summarized recommendations from the 2001 AMIA Spring Congress. JAMIA, vol. 8 (6), p.535-545.

5. Mostashari, F. (2002). Syndromic surveillance in New York City. New York City Department of Health. New York State Sanitary Code, 10 NYCRR Chapter 1, Section 2.16(a). Retrieved June 10th, 2010 from http://www.syndromic.org/syndromicconference/2002/presentationpdf/farzad_mostashari.pdf.

Lecture 1b Charts, Tables and Figures



http://www.syndromic.org/syndromicconference/2002/presentationpdf/farzad_mostashari.pdf


http://www.ph.ucla.edu/epi/snow.html

http://www.phdsc.org/

http://www.surgeongeneral.gov/library/secondhandsmoke/report/fullreport.pdf

http://www.healthypeople.gov/hp2020/advisory/PhaseI/sec4.htm





http://www.iom.edu/~/media/Files/Report%20Files/2002/The-Future-of-the-Publics-Health-in-the-21st-Century/Flores.pdf.%20

http://www.iom.edu/~/media/Files/Report%20Files/2002/The-Future-of-the-Publics-Health-in-the-21st-Century/Flores.pdf.%20

http://ucatlas.ucsc.edu/spend.php


1.1 Table: Mokdad, A.H., Marks, J.S., Stroup, D.F., and Gerberding, J.L. (2004). Actual causes of death in the United States, 2000. JAMA, vol,291(110), p. 1238-1245.

Lecture 1b ImagesSlide 6: Self-created map of London water pumps using Epi Map Generated using CDC Epi Map Module in Epi Info 2000 for Windows, a public domain package that can be downloaded from: http://www.cdc.gov/epiinfo/EI2000.htm Slide 7: Retrieved June 10th, 2010 from http://www.flickr.com/photos/lwr/4346005957/sizes/l/#cc_license Slide 8: Retrieved June 10th, 2010 from http://www.cdc.gov/nchs/healthy_people/hp2010/data2010.htm Slide 10: Retrieved June 10th, 2010 from https://www.google.com/images.Slide 14: Mostashari, F. (2002). Syndromic surveillance in New York City. New York City Department of Health. New York State Sanitary Code, 10 NYCRR Chapter 1, Section 2.16(a). Retrieved June 10th, 2010 from http://www.syndromic.org/syndromicconference/2002/presentationpdf/farzad_mostashari.pdf Slide 16: Mostashari, F. (2002). Syndromic surveillance in New York City. New York City Department of Health. New York State Sanitary Code, 10 NYCRR Chapter 1, Section 2.16(a). Retrieved June 10th, 2010 from http://www.syndromic.org/syndromicconference/2002/presentationpdf/farzad_mostashari.pdf.Slide 20: Tobacco cessation aids sold at large pharmacy chains. Retrieved on August 10th, 2010 from www.publichealth.va.gov/docs/smoking/smoking_mentalhealth.pdf Slide 21: New York City Department of Health Triennial report (2006). Retrieved on August 10th, 2010 from http://www.nyc.gov/html/doh/downloads/pdf/public/triennial_report.pdf Slide 22: McGinnis, J.M., and Foege, W.H. (1993). Actual causes of death in the United States. JAMA270(18), p.2207-2212.Slide 23-30: Centers for Disease Control and Prevention: Obesity trends among U.S adults between 1985-2010. Retrieved June 10th, 2010 from www.cdc.gov/obesity/downloads/obesity_trends_2010.ppt. Slide 31: HealthCare Spending and Life Expectancy. Retrieved on June 10 th, 2010 from http://ucatlas.ucsc.edu/spend.phpSlide 32: Hanrachan, L.P. (2004). Public health informatics the Wisconsin Idea. PHDSC Annual meeting. Retrieved June 10th, 2010 from www.phdsc.org. Slide 34: Kukafka, R., Ancker, J.S., Chan, C., et al. (2007). Redesigning electronic health record systems to support public health. Journal of Biomedical Informatics, vol.40(special issues), p. 398-409. Slide 38: Flores, G.R. (2002). Implications for public health practice: The future of the Public’s Health in the 21st Century. Institute of Medicine. Retrieved June 10th, 2010 from http://www.iom.edu/~/media/Files/Report%20Files/2002/The-Future-of-the-Publics-Health-in-the-21st-Century/Flores.pdf



http://www.iom.edu/~/media/Files/Report%20Files/2002/The-Future-of-the-Publics-Health-in-the-21st-Century/Flores.pdf

http://www.iom.edu/~/media/Files/Report%20Files/2002/The-Future-of-the-Publics-Health-in-the-21st-Century/Flores.pdf

http://www.phdsc.org/

http://ucatlas.ucsc.edu/spend.php

http://www.cdc.gov/obesity/downloads/obesity_trends_2010.ppt

http://www.nyc.gov/html/doh/downloads/pdf/public/triennial_report.pdf

http://www.publichealth.va.gov/docs/smoking/smoking_mentalhealth.pdf





https://www.google.com/images

http://www.cdc.gov/nchs/healthy_people/hp2010/data2010.htm

http://www.flickr.com/photos/lwr/4346005957/sizes/l/

http://www.cdc.gov/epiinfo/EI2000.htm

Suggested ReadingsNone

Student Application Activitiescomp13_unit1_discuss.doc comp13_unit1_discuss_key.doccomp13_unit1_self_assess.doccomp13_unit1_self_assess_key.doc



Component 13/Unit 2

Unit TitlePrivacy, Confidentiality and Security of Public Health Information

Unit DescriptionApply health data definitions and standards, as well as privacy and confidentiality issues, in typical public health scenarios.

[Note: This outcome applies jointly to units 2 and 3, which are related.]


1. Identify the exercise of principles of privacy, confidentiality, and security of public health information, in scenarios involving patients and health practitioners.

2. Identify the types of laws/Acts applicable to the treatment of public health information.

3. Locate resources for applicable state, local, and federal laws and/or Acts4. Interpret the treatment of and apply applicable laws/Acts to public health

information in given patient or practitioner scenarios.5. Identify the functions of a “covered entity” and a “business associate” in

relation to the treatment of public health information. 6. Describe the objectives and roles of the HIPAA Privacy Rule and

exceptions to HIPAA as they apply to public health.7. Identify patient rights under the Notice of Privacy Practices8. Describe the potential civil and criminal penalties for a HIPAA violation9. Identify and summarize each HIPAA security requirement (administrative,

physical, and technical) 10.Discuss policy, procedures, contracts, and plans in administrative

safeguards11.Describe how the physical environment can impact security of information

and develop solutions12.Discuss technical strategies that can be implemented for security

purposes13. Identify the type of information that requires protection (e.g., diseases,

demographics) and list examples 14.Demonstrate the application of principles for the appropriate release of

required patient information in given scenarios. 15. Identify examples of circumstances when patient information may be used

without patient authorization. 16.Summarize the ARRA/HITECH amendments to HIPAA.



Unit Topics / Lecture Titles A. PrivacyB. ConfidentialityC. SecurityD. Laws, Acts & Public HealthE. Statutory & RegulatoryF. Health Insurance portability and Accountability Act


Lecture1. Disclosures for Public Health Agencies. Retrieved on June 10, 2010 from

http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/publichealth/publichealth.pdf

2. HIPAA Privacy Rule and Public Health. Retrieved on June 10, 2010 from http://www.cdc.gov/mmwr/preview/mmwrhtml/m2e411a1.htm

3. Retrieved on June 10, 2010 from HIPAA: http://www.hhs.gov/ocr/privacy / 4. Regulatory Guidance. Retrieved on June 10, 2010 from

http://www.cms.gov/home/regsguidance.asp 5. Turning Point Model State Public Health Act. Retrieved on June 10, 2010 from

http:// www.publichealthlaw.net/ModelLaws/MSPHA.php 6. Center for Law & Public Health. Retrieved on June 10, 2010 from

http://www.publichealthlaw.net / 7. Retrieved on June 10, 2010 from http:// www.publichealthlaw.net/links.php 8. Federal Register. Retrieved on June 10, 2010 from http://www.gpoaccess.gov/fr/ 9. Federal Register ARRA Changes to HIPAA. Retrieved on June 10, 2010 from

http:// www.hhs.gov/ocr/privacy/hipaa/administrative/enforcementrule/enfifr.pdf 10.Office of Civil Rights. Retrieved on June 10, 2010 from http://www.hhs.gov/ocr/ 11.Center for Medicare and Medicaid. Retrieved on June 10, 2010 from

http://www.cms.gov / 12.Centers for Disease Control and Prevention. Retrieved on June 10, 2010 from

http://www.cdc.gov / 13.The American Health Information Management Association (AHIMA). Retrieved

on June 10, 2010 from http://www.ahima.org / 14.Breaches and Resources. Retrieved on June 10, 2010 from

http://www.phiprivacy.net/ 15.Government Security. Retrieved on June 10, 2010 from

http://www.govinfosecurity.com/index.php 16.Health Data Management. Retrieved on June 10, 2010 from

http://www.healthdatamanagement.com/ 17.HIPAA Proposed Rule for Accounting of Disclosures. Retrieved on June 10, 2010

from http://www.gpo.gov/fdsys/pkg/FR-2011-05-31/pdf/2011-13297.pdf



http://www.gpo.gov/fdsys/pkg/FR-2011-05-31/pdf/2011-13297.pdf

http://www.healthdatamanagement.com/

http://www.govinfosecurity.com/index.php

http://www.phiprivacy.net/

http://www.ahima.org/

http://www.ahima.org/

http://www.cdc.gov/

http://www.cdc.gov/

http://www.cms.gov/

http://www.cms.gov/

http://www.hhs.gov/ocr/

http://www.hhs.gov/ocr/privacy/hipaa/administrative/enforcementrule/enfifr.pdf

http://www.hhs.gov/ocr/privacy/hipaa/administrative/enforcementrule/enfifr.pdf

http://www.gpoaccess.gov/fr/

http://www.publichealthlaw.net/links.php

http://www.publichealthlaw.net/links.php

http://www.publichealthlaw.net/

http://www.publichealthlaw.net/

http://www.publichealthlaw.net/ModelLaws/MSPHA.php

http://www.publichealthlaw.net/ModelLaws/MSPHA.php

http://www.cms.gov/home/regsguidance.asp

http://www.hhs.gov/ocr/privacy/

http://www.hhs.gov/ocr/privacy/

Suggested ReadingsNone




Component 13/Unit 3

Unit TitleData Standards in Public Health Information Technology

Unit DescriptionApply health data definitions and standards, as well as privacy and confidentiality issues, in typical public health scenarios.[Note: This outcome applies jointly to units 2 and 3, which are related.]


1. Discuss the New York City Department of Health and Mental Hygiene partnership with a commercial EHR vendor and how it created a public health-enabled EHR.

2. Demonstrate knowledge of public health-oriented clinical decision support including an integrated strategy using multiple tools such as alerts, order sets, smart forms, and quality reporting.

3. Describe the EHR "meaningful use" movement and how it could transform existing clinical/public health practices.

4. Describe the strategies, features, and systems needed for public health agencies to define and build the necessary connections to EHRs as identified by the "meaningful use" legislation.

5. Identify the essential features of four primary public health IT functions, including syndromic surveillance, bi-directional immunization registries, public health alerts, ad-hoc reporting, and more.

Unit Topics / Lecture Titles A. Identify the architecture categories for information systems and explain the differencesB. Summarize objectives of an enterprise architecture planC. Identify the objectives of data standards for public health D. Describe the different types of standards required (e.g., information, clinical data representation, technical, medication terminology, and privacy and security)E. Identify the factors involved in grammar data standards for communicating in public health informaticsF. Identify the principles of context regarding data standards for communicating public health informaticsG. Identify universal vocabularies and classification systems applicable to public health (CPT, ICD-0)H. Identify and compare associations and/or organizations developing standards (e.g., CCHIT, HL7, American Society for Testing and Materials)




Lecture1. Public Health Informatics and Information Systems edited by Patrick W.

O’Carroll, William A. Yasnoff, M. Elizabeth Ward, Laura H. Ripp, & Ernest L. Martin, 2003 ISBN 0-387-95474-0

2. Accredited Standards Committee X12. Retrieved on July 10th, 2010 from http://www.x12.org/

3. American College of Radiology national Electrical Manufactures Association (ACR-NEMA). Retrieved on July 10th, 2010 from http://www.nema.org/media/pr/20061101a.cfm

4. HL7. Retrieved on July 10th, 2010 from http://www.hl7.org/ 5. CCHIT. Retrieved on July 10th, 2010 from http://www.cchit.org/ 6. Institute of Electrical and Electronics Engineers. Retrieved on July 10th, 2010

from http://www.ieee.org/index.html 7. American Society for Testing & Materials. Retrieved on July 10th, 2010 from

http://www.astm.org/ 8. National Council for Prescription Drug Programs. Retrieved on July 10th, 2010

from http://www.ncpdp.org/standards.aspx 9. Public Health Informatics Institute. Retrieved on July 10th, 2010 from

http://www.phii.org/ 10.Mapping and Public Health. Retrieved on July 10th, 2010 from

http://gamapserver.who.int/mapLibrary/ 11.Agency for Toxic Substances & Disease Registry. Retrieved on July 10th, 2010

from http://www.atsdr.cdc.gov/ 12.Office of Surveillance, Epidemiology, and Laboratory Services. Retrieved on July

10th, 2010 from http://www.cdc.gov/osels/ 13.National Institute of Standards and Technology. Retrieved on July 10th, 2010

from http://www.nist.gov/index.html 14.Computer Security Division Community Security Resource Center. Retrieved on

July 10th, 2010 from http://csrc.nist.gov/index.html 15.Nationally Notifiable Diseases Surveillance System. Retrieved on July 10th, 2010

from http://www.cdc.gov/osels/ph_surveillance/nndss/nndsshis.htm 16.Clinical and Laboratory Standards Institute (CLSI). Retrieved on July 10 th, 2010

from http://www.clsi.org/ 17.Clinical Data Interchange Standards Consortium. Retrieved on July 10th, 2010

from http://www.cdisc.org/ 18.Designated Standard Maintenance Organization (DSMO). Retrieved on July 10 th,

2010 from http://www.cdisc.org/ 19.Health Industry Business Communications Council (HIBCC). Retrieved on July

10th, 2010 from http://www.hibcc.org/ 20. International Organization for Standardization (ISO). Retrieved on July 10 th, 2010

from http://www.iso.org/iso/home.htm



http://www.iso.org/iso/home.htm

http://www.hibcc.org/

http://www.cdisc.org/


http://www.clsi.org/

http://www.cdc.gov/osels/ph_surveillance/nndss/nndsshis.htm

http://csrc.nist.gov/index.html

http://www.nist.gov/index.html

http://www.cdc.gov/osels/

http://www.atsdr.cdc.gov/

http://gamapserver.who.int/mapLibrary/

http://www.phii.org/

http://www.ncpdp.org/standards.aspx

http://www.astm.org/

http://www.ieee.org/index.html

http://www.hl7.org/

http://www.nema.org/media/pr/20061101a.cfm

http://www.x12.org/

21.National Information Standards Organization (NISO). Retrieved on July 10th, 2010 from http://www.niso.org/home/

22.National Uniform Billing Committee (NUBC). Retrieved on July 10th, 2010 from http://www.nubc.org/

23.Analysis of Unique Patient Identifier Options Final report. Retrieved on July 10 th, 2010 from http://ncvhs.hhs.gov/app0.htm

24.Reliable Patient Identification Project. Retrieved on July 10 th, 2010 from http://whinit.org/reliable-patient-identification-project/

25.Global Patient Identifiers. Retrieved on July 10th, 2010 from http://gpii.info/ 26.Sample Universal Healthcare Identifier. Retrieved on July 10th, 2010 from

http://ncvhs.hhs.gov/app7-2.htm 27.Gartner Healthcare Presentation. Retrieved on July 10th, 2010 from

http://www.gartner.com/it/content/530400/530411/ks_hc_nov.pdf 28.White Paper Unique Health Identifier for Individuals. Retrieved on July 10 th, 2010

from http ://epic.org/privacy/medical/hhs-id-798.html 29.AHIMA Industry Standards and Activities. Retrieved on July 10th, 2010 from

http://www.ahima.org/advocacy/healthinformationexchange.aspx 30.HIMSS Health Information Exchange http://www.himss.org/ASP/topics_rhio.asp 31. Institute of Medicine Recommendation for a National Chronic Disease

Surveillance System http://www.iom.edu/Reports/2011/A-Nationwide-Framework-for-Surveillance-of-Cardiovascular-and-Chronic-Lung-Diseases.aspx

32.Shapiro, J. S. Evaluating Public health uses of health information exchange. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2137930/

33.HIMSS Overview of HIE & RHIOs. Retrieved on July 10th, 2010 from www.himss.org/content/files/RHIO/RHIO_HIE_11_10_07.pdf

34.Association for Information and Image Management:. Retrieved on July 10 th, 2010 from http://www.aiim.org/

35.American Dental Association. Retrieved on July 10th, 2010 from http ://www.ada.org/

36.O’Carroll, P.W., Yasnoff, W.A., Ward, M.E., Ripp, L.H., Martin, E.L. (2003). Public health informatics and information systems. Springer- Verlag Publisher, New York, NY.

Lecture ImagesSlide 14: Public Domain, 2011.

Suggested Readings1. Accredited Standards Committee X12: http://www.x12.org/2. American College of Radiology national Electrical Manufactures Association

(ACR-NEMA): http://www.nema.org/media/pr/20061101a.cfm3. HL7: http://www.hl7.org/4. CCHIT:http://www.cchit.org/5. Institute of Electrical and Electronics Engineers: http://www.ieee.org/index.html6. American Society for Testing & Materials: http://www.astm.org/



http://www.astm.org/

http://www.ieee.org/index.html

http://www.cchit.org/

http://www.hl7.org/

http://www.nema.org/media/pr/20061101a.cfm

http://www.x12.org/

http://www.ada.org/

http://www.ada.org/

http://www.aiim.org/

http://www.himss.org/content/files/RHIO/RHIO_HIE_11_10_07.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2137930/

http://www.iom.edu/Reports/2011/A-Nationwide-Framework-for-Surveillance-of-Cardiovascular-and-Chronic-Lung-Diseases.aspx

http://www.iom.edu/Reports/2011/A-Nationwide-Framework-for-Surveillance-of-Cardiovascular-and-Chronic-Lung-Diseases.aspx

http://www.himss.org/ASP/topics_rhio.asp

http://www.ahima.org/advocacy/healthinformationexchange.aspx

http://epic.org/privacy/medical/hhs-id-798.html


http://www.gartner.com/it/content/530400/530411/ks_hc_nov.pdf

http://ncvhs.hhs.gov/app7-2.htm

http://gpii.info/

http://whinit.org/reliable-patient-identification-project/

http://ncvhs.hhs.gov/app0.htm

http://www.nubc.org/

http://www.niso.org/home/

7. National Council for Prescription Drug Programs: http://www.ncpdp.org/standards.aspx

8. Public Health Informatics Institute: http://www.phii.org/9. Mapping and Public Health: http://gamapserver.who.int/mapLibrary/10.Agency for Toxic Substances & Disease Registry: http://www.atsdr.cdc.gov/11.Office of Surveillance, Epidemiology, and Laboratory Services:

http://www.cdc.gov/osels/12.National Institute of Standards and Technology: http://www.nist.gov/index.html13.Computer Security Division Community Security Resource Center:

http://csrc.nist.gov/index.html14.Nationally Notifiable Diseases Surveillance System:

http://www.cdc.gov/osels/ph_surveillance/nndss/nndsshis.htm15.Association for Information and Image Management: http://www.aiim.org/16.American Dental Association: http://www.ada.org/17.Clinical and Laboratory Standards Institute (CLSI): http://www.clsi.org/18.Clinical Data Interchange Standards Consortium: http://www.cdisc.org/19.Designated Standard Maintenance Organization (DSMO): http://www.cdisc.org/20.Health Industry Business Communications Council (HIBCC):

http://www.hibcc.org/21. International Organization for Standardization (ISO):

http://www.iso.org/iso/home.htm22.National Information Standards Organization (NISO): http://www.niso.org/home/23.National Uniform Billing Committee (NUBC): http://www.nubc.org/24.Analysis of Unique Patient Identifier Options Final report

http://ncvhs.hhs.gov/app0.htm25.Reliable Patient Identification Project http://whinit.org/reliable-patient-

identification-project/ 26.Global Patient Identifiers http://gpii.info/27.Sample Universal Healthcare Identifier http://ncvhs.hhs.gov/app7-2.htm28.Gartner Healthcare Presentation

http://www.gartner.com/it/content/530400/530411/ks_hc_nov.pdf29.White Paper Unique Health Identifier for Individuals:

http://epic.org/privacy/medical/hhs-id-798.html30.AHIMA Industry Standards and Activities

http://www.ahima.org/advocacy/healthinformationexchange.aspx31.HIMSS Overview of HIE & RHIOs

www.himss.org/content/files/RHIO/RHIO_HIE_11_10_07.pdf32.HIMSS Health Information Exchange http://www.himss.org/ASP/topics_rhio.asp33. Institute of Medicine Recommendation for a National Chronic Disease

Surveillance System http://www.iom.edu/Reports/2011/A-Nationwide-Framework-for-Surveillance-of-

34.Cardiovascular-and-Chronic-Lung-Diseases.aspx Shapiro, J. S. Evaluating Pulic health uses of health information exchange. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2137930/



http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2137930/

http://www.iom.edu/Reports/2011/A-Nationwide-Framework-for-Surveillance-of-

http://www.iom.edu/Reports/2011/A-Nationwide-Framework-for-Surveillance-of-

http://www.himss.org/ASP/topics_rhio.asp

http://www.himss.org/content/files/RHIO/RHIO_HIE_11_10_07.pdf

http://www.ahima.org/advocacy/healthinformationexchange.aspx


http://www.gartner.com/it/content/530400/530411/ks_hc_nov.pdf

http://ncvhs.hhs.gov/app7-2.htm

http://gpii.info/



http://ncvhs.hhs.gov/app0.htm

http://www.nubc.org/

http://www.niso.org/home/

http://www.iso.org/iso/home.htm

http://www.hibcc.org/



http://www.clsi.org/

http://www.ada.org/

http://www.aiim.org/

http://www.cdc.gov/osels/ph_surveillance/nndss/nndsshis.htm

http://csrc.nist.gov/index.html

http://www.nist.gov/index.html

http://www.cdc.gov/osels/



http://www.phii.org/

http://www.ncpdp.org/standards.aspx

35.The Nationwide Privacy and Security Framework for Electronic Exchange of Individually Identifiable Health Information http://www.hhs.gov/healthit/privacy/framework.html

36.Privacy and Security and Health Information Technology (Health IT) http://www.hhs.gov/healthit/privacy/

37.Healthcare Information Technology Standards Panel http://www.hitsp.org/default.aspx




http://www.hitsp.org/default.aspx

http://www.hhs.gov/healthit/privacy/

http://www.hhs.gov/healthit/privacy/framework.html

Component 13/Unit 4

Unit TitlePublic Health Enabled Electronic Health Records and the Role of Public Health in Health Information Exchange

Unit DescriptionThis unit will summarize/describe the main role, functions and applications of public health-enabled Electronic Health Records (EHRs).

Unit ObjectivesBy the end of this unit, the student will be able to:

1. Discuss the New York City Department of Health and Mental Hygiene partnership with a commercial EHR vendor and how it created a public health-enabled EHR.

2. Demonstrate knowledge of public health-oriented clinical decision support including an integrated strategy using multiple tools such as alerts, order sets, smart forms, and quality reporting.

3. Describe the EHR "meaningful use" movement and how it could transform existing clinical/public health practices.

4. Describe the strategies, features, and systems needed for public health agencies to define and build the necessary connections to EHRs as identified by the "meaningful use" legislation.

5. Identify the essential features of four primary public health IT functions, including syndromic surveillance, bi-directional immunization registries, public health alerts, ad-hoc reporting, and more.

Unit Topics / Lecture Titles A. Public health enabled electronic health records and the role of public health in health information exchange.B. New York City Public Health GoalsC. Syndromic SurveillanceD. Immunization RegistriesE. Public Health Alerts & Ad-Hoc Reporting


Lecture 4a1. Singh MP. Project Management: Lessons from the Primary Care Information

Project. In Medical Informatics. An Executive Primer. Editor Ong K. 2011 Healthcare Information and Management Systems Society (HIMSS), Chicago Ill. Second Edition Chapter 11. 199-214.



2. Dr. Farzad Mostashari is currently serving as Deputy National Coordinator for Programs and Policy http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=1249&PageID=18220

3. Mostashari F, Tripathi M, Kendall M. A tale of two large community electronic health record extension projects. Health Aff (Millwood). 2009 Mar-Apr;28(2):345-56.

4. Primary Care Information Project. Accessed: October 1, 2010 from http://www.nyc.gov/pcip

Lecture 4a Charts, Tables, Figures1.1 Table: DeLeon S, Shih SC. Tracking the delivery of prevention-oriented care among primary care providers who have adopted electronic health records. J Am Med Inform Assoc. (2011), ahead of print. August 19, 2011.

Lecture 4a ImageSlide 5: Primary Care Information Project. Accessed: October 1, 2010 from http://www.nyc.gov/pcip.

Lecture 4b1. Plagianos M, Buck MD, et al. Syndromic Surveillance during Pandemic (H1N1)

2009 Outbreak. Emerging Infectious Diseases. 2011 Sept;17(9).1724-6.2. Amirfar S, Taverna J, Anane S, Singer J. Developing Public Health Clinical

Decision Support Systems (CDSS) for the Outpatient Community in New York City: Our Experience. BMC Public Health. (Accepted for publication)

Lecture 4b Charts, Tables, Figures1.1 Table: Buck, M. (2010). Syndromic data. New York Department of Health and Mental Hygiene, Primary Care Information Center.

Lecture 4b ImagesSlide 6-14 & 18: Buck, M. (2010). Example images of eclinicalworks: personal desktop. New York Department of Health and Mental Hygiene, Primary Care Information Center. Slide 20: Buck, M. (2010). 7 Day average percent of ILI visits by age group. New York Department of Health and Mental Hygiene, Primary Care Information Center.Slide 21: Buck, M. (2010). All ages percent of visits related to ILI. New York Department of Health and Mental Hygiene, Primary Care Information Center.

Lecture 4c1. Buck MD, Anane S, Taverna J, Amirfar S, Singer J. The Hub Population Health

System: Distributed Ad-Hoc Queries and Alerts. J Am Med Inform Assoc. 2. Standards & Interoperability (S&I) Framework – Query Health. Retrieved on

October 3rd, 2010 from http://wiki.siframework.org/Query+Health 3. Diamond CC, Mostashari F, Shirky C. Collecting and sharing data for population

health: a new paradigm. Health Aff (Millwood). 2009 Mar-Apr;28(2):454-66.



http://wiki.siframework.org/Query+Health

http://www.nyc.gov/pcip

http://www.nyc.gov/pcip

http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=1249&PageID=18220


4. Hripcsak G, Soulakis ND, Li L, Morrison FP, Lai AM, Friedman C, Calman NS, Mostashari F. Syndromic Surveillance Using Ambulatory Electronic Health Records. J Am Med Inform Assoc. 2009 Mar 4. [Epub ahead of print]

5. Lurio J, Morrison FP, Pichardo M, Berg R, Buck MD, Wu W, Kitson K, Mostashari F, Calman N. Using electronic health record alerts to provide public health situational awareness to providers. J Am Med Inform Assoc. 2010 Mar 1;17(2):217-9.

6. Stockwell M, et al. Using an Electronic Immunization Information System to Improve Immunization Rates. Retrieved on October 1, 2010 from http://www.childrenshospitals.net/Content/ContentFolders34/EducationMeetings2/SpringConference/2010/Posters/PHIT/UsinganElectronic-PHIT_poster.pdf

Lecture 4c ImagesSlide 8: Web file repository. Retrieved on September 8, 2010 from www.nyc.gov/html/doh/downloads/pdf/cir/wfr106-07302008.pdf Slide 9: Buck, M. (2010). EHR immunization data- screen shot. New York Department of Health and Mental Hygiene, Primary Care Information Center. Slide 10: Buck, M. (2010). EHR-CIR bi-directional web-services. New York Department of Health and Mental Hygiene, Primary Care Information Center. Slide 12: Buck, M. (2010). EHRs using the service. Retrieved on September 8th, 2010 from http://www.childrenshospitals.net/Content/ContentFolders34/EducationMeetings2/SpringConference/2010/Posters/PHIT/UsinganElectronic-PHIT_poster.pdf Slide 16 & 17: Buck, M. (2010). Images of desktop- systems and query building. New York Department of Health and Mental Hygiene, Primary Care Information Center.Slide 18-21: Buck, M. (2010). Images of desktop- systems of eclinicalworks system. New York Department of Health and Mental Hygiene, Primary Care Information Center.

Suggested Readings1. Mostashari F, Tripathi M, Kendall M. A tale of two large community electronic

health record extension projects. Health Aff (Millwood). 2009 Mar-Apr;28(2):345-56.

2. Diamond CC, Mostashari F, Shirky C. Collecting and sharing data for population health: a new paradigm. Health Aff (Millwood). 2009 Mar-Apr;28(2):454-66.

3. Hripcsak G, Soulakis ND, Li L, Morrison FP, Lai AM, Friedman C, Calman NS, Mostashari F. Syndromic Surveillance Using Ambulatory Electronic Health Records. J Am Med Inform Assoc. 2009 Mar 4. [Epub ahead of print]

4. Dr. Farzad Mostashari is currently serving as Deputy National Coordinator for Programs and Policy http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=1249&PageID=18220

5. Lurio J, Morrison FP, Pichardo M, Berg R, Buck MD, Wu W, Kitson K, Mostashari F, Calman N. Using electronic health record alerts to provide public health situational awareness to providers. J Am Med Inform Assoc. 2010 Mar 1;17(2):217-9.





http://www.childrenshospitals.net/Content/ContentFolders34/EducationMeetings2/SpringConference/2010/Posters/PHIT/UsinganElectronic-PHIT_poster.pdf


http://www.nyc.gov/html/doh/downloads/pdf/cir/wfr106-07302008.pdf






Component 13/Unit 5

Unit TitleEpidemiology Databases and Registries-Public Health Information Tools

Unit DescriptionThis unit will explain how varying types of information technologies have application in public health practice.

Unit Objectives By the end of this unit the student will be able to:

1. Identify the functions and key issues of epidemiology compared to clinical practice

2. Define and distinguish among the components that make up epidemiology3. Identify the difference between environmental and mechanistic causes of

disease4. Describe the components of epidemiological reasoning5. List the different types of epidemiology6. Define clinical epidemiology and its relationship with evidence-based

practice7. Explain the current applications of epidemiology and how the results

influence evidence-based practice8. Identify different sources of epidemiological databases and how

information is updated and exchanged with clinical entities9. Describe the purpose of a registry, the types of information contained

within a public health registries and how this information can be used10. Identify the defining characteristics of epidemiological registries11. Identify different entities that operate registries and how information from

clinical practice gets imported into these registries12. Identify security and access issues in the information exchange between

communities, clinical institutions, public health departments and federal agencies involved in public health prevention and control.

Unit Topics A. Epidemiology- IntroductionB. Epidemiology Databases & RegistriesC. Information Exchange


Lecture 5a1. Improving the Effectiveness of Health Care and Public Health: A Multiscale



Complex Systems Analysis 2. Yaneer Bar-Yam, PhD, March 2006, Vol 96, No. 3 | American Journal of Public

Health 459-4663. Editorial: Clinical Epidemiology – a fast new way to publish important research,

Henrik Toft Sørensen. Published Date February 2009 , Volume 2009:1 Pages 17 – 18

4. Causation and Causal Inference in Epidemiology. Kenneth J. Rothman, DrPH and Sander Greenland, MA, MS, DrPH, C Stat. July 2005, Vol 95, No. S1 | American Journal of Public Health S144-S150

5. Fletcher, H. R., & Fletcher, S. W. (2005). Clinical Epidemiology: The Essentials chapter 1. Retrieved on September 8th, 2011 from www.uwo.ca/ epidem /.../Outlines/.../Epidemiology%209562A.pdf

6. Rizk, S., & Dimitropoulos, L. (2007). A State-Based Approach To Privacy And Security For Interoperable Health Information Exchange. Retrieved on September 8th, 2011 from healthit.ahrq.gov/portal/server.pt/gateway/.../Nationwide.pdf

7. Health Affairs, 28, no. 2 (2009): 428-434. Fletcher R. Clinical epidemiology : the essentials. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.

Lecture 5b1. Data & Statistics. Retrieved on October 3rd, 2011 from

www.cdc.gov/datastatistics 2. National Center for Health Statistics. Retrieved on October 3rd, 2011 from

www.cdc.gov/nchs 3. Resources for Creating PH Maps. Retrieved on October 3rd, 2011 from

www.cdc.gov/epiinfo/maps.htm 4. Wonder Information Site. Retrieved on October 3rd, 2011 from wonder.cdc.gov 5. Behavioral Risk Factor Surveillance System. Retrieved on October 3rd, 2011

from www.cdc.gov/brfss 6. Combined Health Information Database. Retrieved on October 3rd, 2011 from

pathmicro.med.sc.edu/chidmic.htm 7. National Institute of Environmental Health Services. Retrieved on October 3rd,

2011 from www.niehs.nih.gov/research/resources/databases 8. DOE Comprehensive Epidemiologic Data Resource. Retrieved on October 3rd,

2011 from https://www.orau.gov/cedr/ 9. Exposure Assessment Tools & Data. Retrieved on October 3rd, 2011 from

www.epa.gov/ceampubl/tool s10.FedStats. Retrieved on October 3rd, 2011 from www.fedstats.gov /11.Agency for Toxic Substances and Disease Registry. Retrieved on October 3rd,

2011 from12.www.atsdr.cdc.gov/ 13.Surveillance Epidemiology and End Results. Retrieved on October 3rd, 2011

from seer.cancer.gov/ 14.US Census Bureau Data Ferret. Retrieved on October 3rd, 2011 from




http://www.fedstats.gov/

http://www.epa.gov/ceampubl/tool

https://www.orau.gov/cedr/

http://www.niehs.nih.gov/research/resources/databases

http://pathmicro.med.sc.edu/chidmic.htm

http://www.cdc.gov/brfss

http://www.cdc.gov/epiinfo/maps.htm

http://www.cdc.gov/nchs

http://www.cdc.gov/datastatistics

http://www.uwo.ca/epidem/.../Outlines/.../Epidemiology%209562A.pdf



dataferrett.census.gov/ 15.University of California, Berkeley- Human Mortality Database. Retrieved on

October 3rd, 2011 from www.mortality.org/16.American College of Surgeons- National Cancer Database. Retrieved on October

3rd, 2011 from www.facs.org/cancer/ncdb17.North American Association of Central Cancer Registries. Retrieved on October

3rd, 2011 from www.naaccr.org/ 18.March of Dimes- National Perinatal Statistics. Retrieved on October 3rd, 2011

from www.marchofdimes.com/professionals/680_1239.asp 19.Population Reference Bureau- Data Finder. Retrieved on October 3rd, 2011 from

www.prb.org/datafinder.aspx 20.Global Health Observatory. Retrieved on October 3rd, 2011 from

www.who.int/gho/en/ 21.Retrieved on October 3rd, 2011 from www.epidata.dk/ 22.Retrieved on October 3rd, 2011 from

www.openepi.com/Menu/OpenEpiMenu.htm 23.National Trauma Data Bank. Retrieved on October 3rd, 2011 from

http://www.facs.org/trauma/ntdb/index.html 24.Diabetes Registry. Retrieved on October 3rd, 2011 from

http://www.joslin.org/bp/diabetes_registry_tools.html 25.MEDPAR Limited Data Set. Retrieved on October 3rd, 2011 from

http://www.cms.gov/LimitedDataSets/02_MEDPARLDSHospitalNational.asp 26.National Birth Defects Prevention Network. Retrieved on October 3rd, 2011 from

http://www.nbdpn.org/

Lecture 5b ImageSlides 9-13: Retrieved on October 3rd, 2011 from http://www.facs.org/cancer/ncdb/index.html Slide 18: Integrating Informatics Principles in Public Health. Retrieved on July 20th, 2010 from 2010 from: http://apha.confex.com/apha/134am/techprogram/session_19137.htm

Unit Required Readings1. Yam-Bar, Y. (2006). Improving the effectiveness of health care and public health:

a multi-scale complex systems analysis. American Journal of Public Health, V96(3), P.459-466.

2. Editorial: Clinical Epidemiology – a fast new way to publish important research Henrik Toft Sørensen. Published Date February 2009 , Volume 2009:1 Pages 17 18

3. Rothman, J.K., & Greenland, S. (2005). Causation and causal inference in epidemiology. American Journal of Public Health, V.95(S1), S144-S150.

4. Dimitropoulus, L., & Rizk, S. (2009). A state-based approach to privacy and security for interoperable health information exchange. Health Affairs



http://apha.confex.com/apha/134am/techprogram/session_19137.htm

http://www.facs.org/cancer/ncdb/index.html

http://www.nbdpn.org/

http://www.cms.gov/LimitedDataSets/02_MEDPARLDSHospitalNational.asp

http://www.joslin.org/bp/diabetes_registry_tools.html

http://www.facs.org/trauma/ntdb/index.html

http://www.openepi.com/Menu/OpenEpiMenu.htm

http://www.epidata.dk/

http://www.who.int/gho/en/

http://www.prb.org/datafinder.aspx

http://www.marchofdimes.com/professionals/680_1239.asp

http://www.naaccr.org/

http://www.facs.org/cancer/ncdb

http://www.mortality.org/

Unit Suggested Readings1. Improving the Effectiveness of Health Care and Public Health: A Multiscale

Complex Systems Analysis.Yaneer Bar-Yam, PhD March 2006, Vol 96, No. 3 | American Journal of Public Health 459-466

2. Editorial: Clinical Epidemiology – a fast new way to publish important research Henrik Toft Sørensen. Published Date February 2009 , Volume 2009:1 Pages 17 18

3. Causation and Causal Inference in Epidemiology J. Rothman, DrPH and Sander Greenland, MA, MS, DrPH, C Stat July 2005, Vol 95, No. S1 | American Journal of Public Health S144-S150

4. A State-Based Approach to Privacy and Security For Interoperable Health Information Exchange

5. Linda Dimitropoulos and Stephanie Rizk Health Affairs, 28, no. 2 (2009): 428-434 6. Fletcher R. Clinical epidemiology : the essentials. 4th ed. Chapter 1.

Philadelphia: Lippincott Williams & Wilkins; 2005. a “paywall” or not easily accessible, since it is suggested.




Component 13/Unit 6

Unit TitleBiosurvelliance, Situational Awareness and Disaster Response

Unit DescriptionThis unit will focus on identifying current needs and future directions for EHR biosurveillance, disaster-preparedness, and situational awareness in improving public health.


1. Describe the traditional means used to monitor and report on disease spread within a community

2. Identify current data sources used to track disease3. Describe the typical process of syndromic surveillance.4. Identify strengths and weaknesses of using EHRs for biosurveillance 5. Describe process for monitoring, reporting, and analyzing EHR

biosurveillance data6. Identify how current and future findings from EHR biosurveillance improve

public health operations and services

Unit Topics A. Syndromic Surveillance OverviewB. Electronic Health Record Syndromic Surveillance during 2009-Pandemic H1N1 in NYC


Lecture 1. Plagianos M, Buck MD, et al. Syndromic Surveillance during Pandemic (H1N1)

2009 Outbreak. Emerging Infectious Diseases. 2011 Sept;17(9).1724-6.2. Hripcsak G, Soulakis ND, Li L, Morrison FP, Lai AM, Friedman C, Calman NS,

Mostashari F. Syndromic Surveillance Using Ambulatory Electronic Health Records. J Am Med Inform Assoc. 2009 Mar 4. [Epub ahead of print]

Lecture Charts, Tables, Figures1.1 Table: Buck, M. (2010). New and exciting data types. New York Department of Health and Mental Hygiene, Primary Care Information Center.1.2 Table: Buck, M. (2010). Aggregate Level Syndromic Data. New York Department of Health and Mental Hygiene, Primary Care Information Center



1.3 Table: Buck, M. (2010). Data processing and syndrome coding. New York Department of Health and Mental Hygiene, Primary Care Information Center1.4 Table: Buck, M. (2010). A table of results from the first phase of the ILI outbreak- April-May. New York Department of Health and Mental Hygiene, Primary Care Information Center.1.5 Table: Buck, M. (2010). A table of results from the first phase of the ILI outbreak- May-June. New York Department of Health and Mental Hygiene, Primary Care Information Center.

Lecture ImagesSlide 5: Case Definitions for Infectious Conditions under Public Health Surveillance. Retrieved October 1, 2010 from http://www.cdc.gov/osels/ph_surveillance/nndss/casedef/legionellosis_current.htm Slide 7-8: NYC Department of Health & Mental Hygiene Universal Reporting Form. Retrieved on October 1, 2010 from http://www.nyc.gov/html/doh/downloads/pdf/hcp/urf-0803.pdf Slide 12: eClincalWorks System Screenshot used by permission. Slide 17: Buck, M. (2010). Analysis: test observed vs. expected. New York Department of Health and Mental Hygiene.Slides 20-31: Buck, M. (2010). Map of the distribution of ILI in NYC. New York Department of Health and Mental Hygiene, Primary Care Information Center.Slide 34: Buck, M. (2010). A graph of the level of ILI at the emergency departments in red, the PCIP primary care practices in green and the IFH primary care practices in blue. New York Department of Health and Mental Hygiene, Primary Care Information Center.

Unit Suggested Readings1. International Society of Disease Surveillance: http://www.syndromic.org/2. HHS Biosurveillance Use Case3. http://www.hhs.gov/healthit/documents/BiosurveillanceUseCase.pdf 4. NYC Department of Health and Mental Hygiene Influenza Surveillance:5. http://home2.nyc.gov/html/doh/flu/html/data/data.shtml 6. Aaron T Fleischauer, PhD; Pamela S Diaz, MD; Daniel M Sosin MD .

Biosurveillance: 7. A Definition, Scope and Description of Current Capability for a National Strategy.

Advances in Disease Surveillance 2008;5:1758. Hripcsak G, Soulakis ND, Li L, Morrison FP, Lai AM, Friedman C, Calman NS, 9. Mostashari F. Syndromic surveillance using ambulatory electronic health

records.J Am Med Inform Assoc. 2009 May-Jun;16(3):354-61. Epub 2009 Mar 4.10.May LS, Griffin BA, Bauers NM, Jain A, Mitchum M, Sikka N, Carim M, Stoto MA.11.Emergency department chief complaint and diagnosis data to detect influenza-

like illness with an electronic medical record. West J Emerg Med. 2010 Feb;11(1):1-9.

12.Yih WK, Caldwell B, Harmon R, Kleinman K, Lazarus R, Nelson A, Nordin J,



http://home2.nyc.gov/html/doh/flu/html/data/data.shtml

http://www.hhs.gov/healthit/documents/BiosurveillanceUseCase.pdf

http://www.syndromic.org/

http://www.nyc.gov/html/doh/downloads/pdf/hcp/urf-0803.pdf

http://www.nyc.gov/html/doh/downloads/pdf/hcp/urf-0803.pdf

http://www.cdc.gov/osels/ph_surveillance/nndss/casedef/legionellosis_current.htm

13.Rehm B, Richter B, Ritzwoller D, Sherwood E, Platt R. National Bioterrorism Syndromic Surveillance Demonstration Program. MMWR Morb Mortal Wkly Rep. 2004 Sep 24;53 Suppl:43-9.

14.Greenko J, Mostashari F, Fine A, Layton M. Clinical evaluation of the 15.Emergency Medical Services (EMS) ambulance dispatch-based syndromic

surveillance system, New York City. J Urban Health. 2003 Jun;80(2 Suppl 1):i50-6.




Component 13/Unit 7

Unit TitlePublic Health Reporting, Alerts and Decision Support

Unit DescriptionThis unit will summarize the essential public health services and methods by which they can be improved through the use of EHRs in the context of the clinical care environment.


1. Describe the current role of public health in the context of the clinical care environment

2. Identity and describe three essential to public health services: Monitor Health; Diagnose/Investigate; Inform, Educate, Empower

3. Identify current public health practices challenges in the essential public health services of: Monitor Health; Diagnose/Investigate; and Inform, Educate, Empower

4. Identify the opportunities and limitations for EHRs to address these challenges in three primary areas (syndromic surveillance, notifiable disease reporting, and public health case investigation)

5. Describe challenges & limitations of EHRs to address these service areas

Unit Topics / Lecture TitlesA. Public health reporting, alerts, and decision supportB. Monitoring HealthC. Pre-PopulationD. Syndromic ChallengesE. Diagnose & Investigate Health IssuesF. Translating Public Health InformationG. Integration of Public Health Information via Electronic Health RecordsH. Testing Performed at VisitsI. E.Coli Alerts, Legionella Alerts, and Measles Alerts


Lecture 1. Lurio J, Morrison FP, Pichardo M, Berg R, Buck MD, Wu W, Kitson K, Mostashari

F, Calman N. Using electronic health record alerts to provide public health situational awareness to providers. J Am Med Inform Assoc. 2010 Mar 1;17(2):217-9.



2. Hripcsak G, Soulakis ND, Li L, Morrison FP, Lai AM, Friedman C, Calman NS, Mostashari F. Syndromic surveillance using ambulatory electronic health records. J Am Med Inform Assoc. 2009 May-Jun;16(3):354-61.

3. Lazarus R, Klompas M, Campion FX, McNabb SJ, Hou X, Daniel J, Haney G, DeMaria A, Lenert L, Platt R. Electronic Support for Public Health: validated case finding and reporting for notifiable diseases using electronic medical data. J Am Med Inform Assoc. 2009 Jan-Feb;16(1):18-24.

4. Shapiro JS. Evaluating public health uses of health information exchange. J Biomed Inform. 2007 Dec;40(6 Suppl):S46-9.

5. The future of public health. Ten Essential Services. (1988). Institute of Medicine report. Retrieved on October 1st, 2010 from http://www.iom.edu/~/media/Files/Report%20Files/2002/The-Future-of-the-Publics-Health-in-the-21st-Century/Future%20of%20Publics%20Health%202002%20Report%20Brief.pdf

Lecture ImagesSlide 8: Retrieved October 1st, 2010 from http://www.nyc.gov/html/doh/downloads/pdf/hcp/hcp-reporting.pdfSlide 9: Retrieved October 1st, 2010 from http://www.cdc.gov/ncphi/disss/nndss/phs/infdis2010.htmSlide 11: Retrieved October 1st, 2010 from Image is Microsoft office clip art.Slide 12: Wu, W. (2010). Personal image of EHR- pre-population reporting. Primary Care Information Center, New York Department of Health and Mental Hygiene. Slide 14: Sample image of syndromic surveillance compares with WHO viral isolate data during a recent influenza season. Slide 20: Wu, W. (2010). Personal image of Bronx RHIO . Primary Care Information Center, New York Department of Health and Mental Hygiene.Slide 23: Public domain images of cells, European landscape, and pills. Retrieved on October 2st, 2010Slide 24: E-coli alert. (2007). New York City Department of Health and Mental Hygiene.Slide 25: Lurio, J., Morrison, F., Pichardo, M., Berg, R., et al. (2008). Using automated EHR alerts to improve physician reporting. PowerPoint Presentation-Slide 5 at the International Society for Disease Surveillance Annual Conference.Slide 26: Image of two computers sharing information exchange. Public domain image.Slide 27, 28, 29 & 31: Lurio, J., Morrison, F., Pichardo, M., Berg, R., et al. (2008). Using automated EHR alerts to improve physician reporting. PowerPoint Presentation at the International Society for Disease Surveillance Annual Conference.

Lecture Charts, Tables, Figures1.1 Table: Lurio, J., Morrison, F., Pichardo, M., Berg, R., et al. (2008). Using automated EHR alerts to improve physician reporting. PowerPoint Presentation-Slide 15 at the International Society for Disease Surveillance Annual Conference.

Unit Suggested Readings



http://www.cdc.gov/ncphi/disss/nndss/phs/infdis2010.htm

http://www.nyc.gov/html/doh/downloads/pdf/hcp/hcp-reporting.pdf

http://www.iom.edu/~/media/Files/Report%20Files/2002/The-Future-of-the-Publics-Health-in-the-21st-Century/Future%20of%20Publics%20Health%202002%20Report%20Brief.pdf



1. Lurio J, Morrison FP, Pichardo M, Berg R, Buck MD, Wu W, Kitson K, Mostashari 2. F, Calman N. Using electronic health record alerts to provide public health

situational awareness to providers. J Am Med Inform Assoc. 2010 Mar 1;17(2):217-9.

3. Hripcsak G, Soulakis ND, Li L, Morrison FP, Lai AM, Friedman C, Calman NS, 4. Mostashari F. Syndromic surveillance using ambulatory electronic health records.

J Am Med Inform Assoc. 2009 May-Jun;16(3):354-61. 5. Lazarus R, Klompas M, Campion FX, McNabb SJ, Hou X, Daniel J, Haney G, 6. DeMaria A, Lenert L, Platt R. Electronic Support for Public Health: validated case

finding and reporting for notifiable diseases using electronic medical data. J Am Med Inform Assoc. 2009 Jan-Feb;16(1):18-24.

7. Shapiro JS. Evaluating public health uses of health information exchange. J Biomed Inform. 2007 Dec;40(6 Suppl):S46-9.




Component 13/Unit 8

Unit TitleThe potential of public health IT for health promotion and chronic disease prevention

Unit DescriptionThis unit will explain a novel approach to developing and implementing health promotion programs in public health practice.


1. Describe and categorize issues/questions, data sets and factors (variables) that are used in descriptive epidemiology.

2. Describe how evidence-based recommendations may be appropriately used in implementing and evaluating health promotion and disease prevention.

3. Describe different types of health promotion and disease prevention and different methods of enacting health promotion programs.

4. Identify the steps in the process of implementing and evaluating prevention programs and interventions.

5. Identify the clinical preventive services that are linked to health promotion and disease prevention.

6. Describe how informatics can be incorporated into clinical preventive services.

7. Describe the history and foundation of geographic information systems and explain its role in evidence-based practice.

8. Identify the barriers to incorporating public health IT into clinical practice and potential methods for resolving these limitations.

9. Identify the existing and innovative methods for communicating and sharing health information with the public.

Unit Topics / Lecture TitlesA. Descriptive EpidemiologyB. Health ResearchC. Health PreventionD. Intervention MethodsE. InnovationF. Synthesis & TranslationG. Interactive Health Technologies




Lecture 1. Rosenberg, D., & Handler, A. (1998). Descriptive epidemiology and statistical

estimation. Analytic Methods in Maternal and Child Health. Retrieved on October 1st, 2010 from http://www.mendeley.com/research/module-1-descriptive-epidemiology-statistical-estimation /#

2. Gregg, M. (2008). Field Epidemiology: 3rd edition- Chapter 9: Describing the Findings: Descriptive Epidemiology. Oxford University Press. New York, NY

3. Wandersman, A., et. Al. (2008). Bridging the Gap Between Prevention Research and Practice: The Interactive Systems Framework for Dissemination and Implementation. Am J Community Psychol 41:171-181.

4. Saul, J., et al. (2008). Research and action for bridging the gap between prevention research and practice. Am J Community Psychol 41:165-170.

5. Tulchinsky, T.H., Varavikova, E.A. (2009). The new public health:an introduction for the 21st century. Chapter 2: Expanding the Concept of Public Health. Elsevier Academic Press, Burlington, MA.

6. Dabbs-De Vito, A., et al. User-Centered Design and Interactive Health Technologies for Patients. CIN: Computers, Informatics, Nursing. Vol 27, No 3, 175-183.

7. Retrieve on October 1st, 2010 from World Health Organization GIS http://www.who.int/topics/geographic_information_systems/en/

8. Retrieve on October 1st, 2010 from Office of National Coordinator for Health Information Technology http:// healthit.hhs.gov/portal/server.pt? open=512&mode=2&objID=2998&PageID=21233

9. Retrieve on October 1st, 2010 from Center for Innovation and Technology http://citph.org/

10.Retrieve on October 1st, 2010 from Challenge.gov http:// challenge.gov/ 11.Retrieve on October 1st, 2010 from Technology-enabled innovations for

improving children’s health http:// www.childrenspartnership.org/Content/NavigationMenu/Programs/ EHealthAgendaforChildren/TechnologyEnabledInnovations/Technology_Enabled_I.htm

12.Retrieve on October 1st, 2010 from Gesture driven interactive technology http://www.gesturetekhealth.com/

13.Retrieve on October 1st, 2010 from Websites for GIS Health Data http://www-sul.stanford.edu/depts/gis/medical.html

14.Retrieve on October 1st, 2010 from Global Health Observatory Map Gallery http://gamapserver.who.int/mapLibrary/

15.Retrieve on October 1st, 2010 from Georgia Department of Health OASIS http://oasis.state.ga.us/

16.Retrieve on October 1st, 2010 from General Use of GIS in Public Health http://gis.cancer.gov/examples/general.html

17.Retrieve on October 1st, 2010 from Public Health Genomics http://www.cdc.gov/genomics/gtesting/



http://www.cdc.gov/genomics/gtesting/

http://gis.cancer.gov/examples/general.html

http://oasis.state.ga.us/


http://www-sul.stanford.edu/depts/gis/medical.html

http://www-sul.stanford.edu/depts/gis/medical.html

http://www.gesturetekhealth.com/

http://www.childrenspartnership.org/Content/NavigationMenu/Programs/EHealthAgendaforChildren/TechnologyEnabledInnovations/Technology_Enabled_I.htm




http://challenge.gov/

http://challenge.gov/

http://citph.org/




http://www.who.int/topics/geographic_information_systems/en/

http://www.mendeley.com/research/module-1-descriptive-epidemiology-statistical-estimation/



18.Retrieve on October 1st, 2010 from Center for Genomics and Public Health http://depts.washington.edu/cgph/GeneticTesting.htm

19.Retrieve on October 1st, 2010 from California Environmental Health Tracking Program http://www.ehib.org/project.jsp?project_key=EHSS01

20.Retrieve on October 1st, 2010 from California Department of Public Health http://www.cnngis.org/

21.Retrieve on October 1st, 2010 from Public Health & GIS http://www.esri.com/industries/health/public-health/index.html

22.Retrieve on October 1st, 2010 from Personal Health Records http://www.myphr.com/

23.Retrieve on October 1st, 2010 from Centers for Medicare and Medicaid https://www.cms.gov/PerHealthRecords/01_Overview.asp#TopOfPage

24.Retrieve on October 1st, 2010 from CMS EHR Meaningful Use Overview https://www.cms.gov/ehrincentiveprograms/30_Meaningful_Use.asp#BOOKMARK1

25.Retrieve on October 1st, 2010 from HIMSS Personal Health Records for people with chronic conditions http://www.slideshare.net/SheetalDube/himss-personal-health-records-for-people-with-chronic-conditions

26.Retrieve on October 1st, 2010 from Access Health Records Benefits of PHRs http://www.accesshealthrecord.com/advantages.html

27.Retrieve on October 1st, 2010 from National Committee on Vital and Health Statistics http://ncvhs.hhs.gov/0602nhiirpt.pdf

28.Retrieve on October 1st, 2010 from Telemedicine http://www.americantelemed.org/i4a/pages/index.cfm?pageid=3333

29.Retrieve on October 1st, 2010 from Telemedicine and e-health http://www.liebertpub.com/products/product.aspx?pid=54

Student Application ActivitiesComp13_unit8_discuss.doc Comp13_unit8_discuss_key.docComp13_unit8_self_assess.docComp13_unit8_self_assess_key.doc



http://www.liebertpub.com/products/product.aspx?pid=54

http://www.americantelemed.org/i4a/pages/index.cfm?pageid=3333

http://ncvhs.hhs.gov/0602nhiirpt.pdf

http://www.accesshealthrecord.com/advantages.html

http://www.slideshare.net/SheetalDube/himss-personal-health-records-for-people-with-chronic-conditions

http://www.slideshare.net/SheetalDube/himss-personal-health-records-for-people-with-chronic-conditions

https://www.cms.gov/ehrincentiveprograms/30_Meaningful_Use.asp

https://www.cms.gov/ehrincentiveprograms/30_Meaningful_Use.asp

https://www.cms.gov/PerHealthRecords/01_Overview.asp

http://www.myphr.com/

http://www.esri.com/industries/health/public-health/index.html

http://www.cnngis.org/

http://www.ehib.org/project.jsp?project_key=EHSS01

http://depts.washington.edu/cgph/GeneticTesting.htm

Component 13/Unit 9

Unit TitleQuality Reporting

Unit DescriptionThis unit will summarize/describe the main role, functions and applications of public health reporting, alerts and decision support systems.


1. Identify/describe important characteristics and components of useful health care quality measurement systems

2. Identify the past and present efforts to transform medical practice through pay-for-performance initiatives.

3. Identify national group efforts involved in the establishment of quality standards/metrics (NCQA, NQF, etc.) based upon claims and EHR data.

4. Describe how quality metrics are integrated, tracked, and used in EHRs and describe real-world implementations in eClinicalWorks, EPIC, NextGen.

5. Describe the use of EHR-based quality metrics in pay-for-performance incentive projects.

6. Summarize the preliminary findings/conclusions from the EHR pay-for-performance project and possible future directions.

Unit Topics / Lecture TitlesA. Health Systems and Quality Care (Principles)B. Data SourcesC. Pay for Performance Design Quality Measures for RewardsD. using Quality Measures to Achieve Meaningful Use


Lecture 1. Brown, L., Franco, L.M., Rafeh, N. Quality assurance of health care in developing

countries. Retrieved on October 1st, 2010 from http://pdf.usaid.gov/pdf_docs/Pnabq044.pdf

2. Donabedian, A. Evaluating the Quality of Medical. 1966 (reprinted in Milbank Quarterly, 2005, visit: http://www.milbank.org/quarterly/830416donabedian.pdf

3. Retrieved on October 1st, 2010 from What is evidence based medicine? http://www.cebm.net/index.aspx?o=1914

4. Desirable Attributes of HEDIS. Retrieved on October 1st, 2010 from Desirable



http://www.cebm.net/index.aspx?o=1914

http://www.milbank.org/quarterly/830416donabedian.pdf

http://pdf.usaid.gov/pdf_docs/Pnabq044.pdf

http://www.ncqa.org/tabid/415/Default.aspx 5. NQF Measures Evaluation Criteria. Retrieved on October 1st, 2010 from

Desirable http://www.qualityforum.org/Measuring_Performance/Submitting_Standards/Measure_Evaluation_Criteria.aspx

6. Lee TH. (2007). Eulogy for a Quality Measure. N Engl J Med 357:1175-11777. Retrieved on October 1st, 2010 from www.ncqa.org 8. Retrieved on October 1st, 2010 from www.nqf.org 9. Retrieved on October 1st, 2010 from www.aqaalliance.org 10.Retrieved on October 1st, 2010 from

http://www.cms.gov/EHRIncentivePrograms/Downloads/EHR_Incentive_Program_Agency_Training_v8-20.pdf

11.Retrieved on October 1st, 2010 from www.mnmc.org 12.Retrieved on October 1st, 2010 from www.iha.org 13.Retrieved on October 1st, 2010 from www.mhqp.org 14.AHRQ Resources on Pay for Performance (P4P): A Decision Guide for

Purchasers, by R. Adams Dudley and Meredith B. Rosenthal. (Final Contract Report) Rockville, MD: Agency for health care Research and Quality, 2006. AHRQ Pub. No. 06-0047. Retrieved on October 1st, 2010 from http://www.ahrq.gov/qual/p4pguide.htm

15.Retrieved on October 1st, 2010 from PCIP http://www.nyc.gov/html/doh/html/pcip/pcip.shtml

Lecture Charts, Tables, Figures1.1 Table: Shih, S. (2010). Health care quality measurement in use by the health care industry. Primary Care Information Center, New York Department of Health and Mental Hygiene.1.1 Chart: Shih, S. (2010). Distribution of documentation smoking cessation status & cessation intervention. Primary Care Information Center, New York Department of Health and Mental Hygiene.1.2 Table: Shih, S. (2010). Pay for performance design considerations: avoiding unintended consequences. Primary Care Information Center, New York Department of Health and Mental Hygiene.1.3 Table: Shih, S. (2010). Pay for performance design considerations: What Should a Program Pay For? Primary Care Information Center, New York Department of Health and Mental Hygiene.1.4 Table: Shih, S. (2010). Quality measures for rewards “The ABC’s”. Primary Care Information Center, New York Department of Health and Mental Hygiene.1.5 Table: Retrieved on October 1st, 2010 from http:// www.cms.gov/EHRIncentivePrograms/Downloads/EHR_Incentive_Program_Agen cy_Training_v8-20.pdf 1.6 Table: NQF Measures Evaluation Criteria. Retrieved on October 1st, 2010 from http :// www.qualityforum.org/Measuring_Performance/Submitting_Standards/ Measure_Evaluation_Criteria



http://www.qualityforum.org/Measuring_Performance/Submitting_Standards/Measure_Evaluation_Criteria







http://www.nyc.gov/html/doh/html/pcip/pcip.shtml

http://www.ahrq.gov/qual/p4pguide.htm

http://www.mhqp.org/

http://www.iha.org/

http://www.mnmc.org/



http://www.aqaalliance.org/

http://www.nqf.org/

http://www.ncqa.org/

http://www.qualityforum.org/Measuring_Performance/Submitting_Standards/Measure_Evaluation_Criteria.aspx

http://www.qualityforum.org/Measuring_Performance/Submitting_Standards/Measure_Evaluation_Criteria.aspx

http://www.ncqa.org/tabid/415/Default.aspx

Lecture ImagesSlide 8 : Shih, S. (2010). Using EHRs for automated quality reporting. Primary Care Information Center, New York Department of Health and Mental Hygiene.Slide 9: Shih, S. (2010). Quality measures in data warehouse. Primary Care Information Center, New York Department of Health and Mental Hygiene.Slide 18: Shih, S. (2010). Sample provider quality reports from health eHearts. Primary Care Information Center, New York Department of Health and Mental Hygiene.

Unit Suggested ReadingsNone

Student Application ActivitiesComp13_unit9_discuss.doc Comp13_unit9_discuss_key.docComp13_unit9_self_assess.docComp13_unit9_self_assess_key.doc



Component 13/Unit 10

Unit TitleEncouraging Adoption/Use of Population Health Functions for Electronic Health Records (EHRs) and Consumer Functions for Personal Health Records (PHRs)

Unit DescriptionThis unit will delineate the critical role of advocacy in adoption/use of EHRs and consumer functions for PHRs to improve public health.


1. Identify and describe population health functions of EHRs.2. Describe the meaningful use criteria that are applicable to public health,

population health, disease management and prevention. 3. Provide examples of common PHR systems (Microsoft HealthVault,

Vendor-specific PHRs) and identify embedded consumer functions.4. Describe EHR adoption and use, with a focus on fidelity to public health

goals.5. Describe the challenges in and barriers to adoption and use of population

health functions for EHRs and Consumer functions for PHR.6. Explain and apply a rationale that would encourage adoption and use of

public health functions for EHRs and Consumer functions for PHR.7. Demonstrate the ability to formulate a plan to encourage adoption and use

of population health functions for EHRs and Consumer functions for PHR, given a setting, population and workflow environment.

Unit Topics / Lecture TitlesA. Population Health Functions of Electronic Health Records (Introduction)B. Meaningful Use Criteria for Public Health, Population Health, Disease Management & PreventionC. Common Personal Health Record Systems (PHRs)D. Electronic Health Record Adoption and UseE. Barriers to Adoption and Use of Population Health Functions for Electronic Health Records and Personal Health RecordsF. Encourage Adoption and Use of Population Health functions for EHRs and PHRs


Lecture 1. Kindig D, Stoddart G. What Is Population Health? Am J Public Health. 2003

March; 93(3): 380–383.



https://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf.2. Mandl, K.D., Kohane, I.S. (2008). Tectonic SHifts in the health information

economy. New England Journal of Medicine, 358: 1732-1737. Retrieved on October 1st, 2010 from http:// www.nejm.org/doi/full/10.1056/NEJMsb0800220

3. Retrieved on October 1st, 2010 from http:// www.connectingforhealth.org/news/pressrelease_062508.html

4. Retrieved on October 1st, 2010 from http:// www.chcf.org/publications/2010/04/consumers-and-health-information- technology-a-national-survey

5. Retrieved on October 1st, 2010 from http:// www.ahrq.gov/about/annualconf09/moore.htm

6. Retrieved on October 1st, 2010 from https:// www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf

Lecture ImagesSlide 12& 13: Buck, M. (2010). Images of desktop- systems of eclinicalworks system. New York Department of Health and Mental Hygiene, Primary Care Information Center.Slide 16: Retrieved on October 1st, 2010 from https://www.cms.gov/MLNProducts/downloads/CMS_eHR_Tip_Sheet.pdfSlide 27: Image of Microsoft HealthVault. Retrieved on October 1st, 2010 from http://healthvault.com Slide 30-35: Images Retrieved on October 1st, 2010 from http://healthvault.com

Lecture Charts, Tables, Figures1.1 & 1.2 Table: Khan, S. Population health meaningful use measures-list. Department of Biomedical Informatics. Columbia University Medical Center.

Unit Suggested ReadingsNone Student Application Activitiescomp13_unit10_discuss.doc comp13_unit10_discuss_key.doccomp13_unit10_self_assess.doccomp13_unit10_self_assess_key.doc



http://healthvault.com/

http://healthvault.com/

https://www.cms.gov/MLNProducts/downloads/CMS_eHR_Tip_Sheet.pdf

https://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf


http://www.ahrq.gov/about/annualconf09/moore.htm

http://www.ahrq.gov/about/annualconf09/moore.htm

http://www.chcf.org/publications/2010/04/consumers-and-health-information-technology-a-national-survey



http://www.connectingforhealth.org/news/pressrelease_062508.html

http://www.connectingforhealth.org/news/pressrelease_062508.html

http://www.nejm.org/doi/full/10.1056/NEJMsb0800220

http://www.nejm.org/doi/full/10.1056/NEJMsb0800220


Component Acronym Glossary

ABCS- Aspirin therapy, blood pressure control, cholesterol control and smoking cessation interventions ACR-NEMA- American College of Radiology National Electrical Manufactures AssociationAHRQ- The Agency for Health Care Research and Quality AIDS- Acquired Immune Deficiency Syndrome ANSI- American National Standards Institute APHA- American Public Health AssociationAQA- Ambulatory Quality Alliance ARRA- American Reinvestment and Recovery ActASP- Application Service ProviderASPH- Association of Schools of Public Health ASTHO- Association of State and Territorial Health OfficialsASTM- American Society for Testing and Materials BMI- Body Mass IndexBP- Blood pressureBRFSS- Behavioral Risk Factors Surveillance SystemCAHPS- Consumer Assessment of Health Providers Survey CCHIT- Certification Commission for Health Information Technology CCR-Community of Care RecordCDC- Centers for Disease ControlCDER- FDA Center for Drug Evaluation and Research Data Standards Manual CDSS- Clinical Decision Support SystemsCE- Covered Entity CHCs- Community Health Centers CHFC- California Healthcare Foundation CIR- Citywide Immunization Registry CMS- Centers for Medicaid and Medicare ServicesCOC- Commission on Cancer CPOE- Computerized Physician Order Entry CSTE- Council of State and Territorial Epidemiologists CT Scan- Computerized Tomography Scan CUSUM- Cumulative Sum Control Chart DNA- Deoxyribose Nucleic Acid DOHMH- Department of health and Mental Hygiene ECW- eClinicalWorksED- Emergency Department EHEC Infection- Enterohaemorrhagic Escherichia Coli InfectionEHR- Electronic Health RecordEMS- Emergency Medical Services EPA- Environmental Protection Agency f/u- Follow up



FDA- Food and Drug AdministrationFTE- Full Time EmployeeGDP- Gross Domestic ProductGI- Gastrointestinal Illness GIS- Geographical Information Systems HALE- Health Adjusted Life Expectancy HAN- Health Alert Network HbA1c- Hemoglobin A1c HCPCS- Healthcare Common Procedure Coding System HEDIS- Health Care Effectiveness Data and Information Set HHS- Health and Human ServicesHIE- Health Information Exchange HIPAA- Health Insurance Portability and Accountability ActHIT- Health Information TechnologyHITECH- Health Information Technology for Economic and Clinical Health Act HIV- Human Immunodeficiency VirusHL7- Health Level 7HMO- Health Maintenance Organization HQIN-Healthcare Quality Information Network HTML- Hypertext Markup Language ICD-CM/PCS- International Classification of Diseases- Clinical Modification/ Procedural Coding system ICD-O- International Classification of Diseases for Oncology ICU- Intensive Care Unit IEEE- Institute of Electrical and Electronics Engineers IFH- Institute of Family Health IHT- Interactive Health Technologies IIHI- Individually Identifiable Health InformationILI- Influenza like illnessILINET- Influenza –like Illness Network IOM- Institute of Medicine ISDS- International Society for Disease SurveillanceIUFH-Institute for Urban Family Health IVD-Ischemic Vascular Disease JCAHO- Joint Commission on the Accreditation of Hospital Organizations LDl- (Low Density Lipoprotein)—marker for cholesterol level LOINC- Logical Observation Identifiers Names and CodesMCO-Managed Care Organizations MMWR- Morbidity and Mortality Weekly Report MySQL-My Structure Query LanguageNAACCR- North American Association of Central Cancer Registries NACCHO- National Association of Country and City Health Officials NCDB- National Cancer DatabaseNCI- National Cancer Institute



NCPDP- National Council for Prescription Drug ProgramsNCPDP- National Council on Prescription Drug Programs NCQA- National Committee for Quality Assurance NEJM- New England Journal of Medicine NIH- National Institutes of Health NPI- National Provider Identifier NQF- National Quality Forum NRT – Nicotine Replacement TherapyNYC REACH- NYC Regional Electronic Adoption Center for HealthNYP- New York Presbyterian OCR- Office of Civil rights P4P- Pay for performanceP4Q- Pay for qualityPBR- Population Reference Bureau PCIP- The Primary Care Information Project PCMH- Patient Centered Medical HomePCP- Primary Care Provider PDF- Portable Document Format PH HIT- Public Health Information technologyPHI- Protected Health InformationPHR- Personal Health Record QALE*- Quality Adjusted Life Expectancy QALY- Quality adjusted life years QI- quality Improvement RCB- Recognized Certification BodyRHIO- Regional Health Information Organizations SCD- Semantic Clinical Drug of RxNormSDOs- Standard Development OrganizationsSFTP-Secure File Transfer Protocol SNOMED-CT- Systematized Nomenclature of Medicine Clinical TermsSPL- Special Product LabelingSQL code-Structured Query language TCNY- Take Care New York URI- Upper Respiratory Infection USB- Universal Serial Bus VGI- Voluntary Geographic InformationWFR- Web File Repository WHO- World Health Organization XML- Extensible Markup Language



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